Provider Demographics
NPI:1508390295
Name:RUSHFORD, CASSIANAH
Entity Type:Individual
Prefix:
First Name:CASSIANAH
Middle Name:
Last Name:RUSHFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2340 TORRENT ST
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441-1565
Mailing Address - Country:US
Mailing Address - Phone:906-399-4614
Mailing Address - Fax:
Practice Address - Street 1:2340 TORRENT ST
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441-1565
Practice Address - Country:US
Practice Address - Phone:906-399-4614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-19
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1-17-25203103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst